News and Updates for Healthcare Professionals

NIH scientists link genetics to risk of high blood pressure among blacks

Study team identified 17 variants in the ARMC5 gene that were associated with high blood pressure by analyzing genetic research databases that include those of African descent.

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Trump Administration Approves Two New State Medicaid Demonstrations to Treat Substance Use Disorders and Combat National Opioid Epidemic

The Centers for Medicare and Medicaid Services (CMS) announced today that Minnesota and Nebraska have become the 23rd and 24th states who have received approval under the Trump Administration for innovative demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). 

Under the section 1115 demonstrations, Minnesota and Nebraska are approved to receive Medicaid matching funds for treatment in facilities that meet the definition of an institution for mental diseases (IMD). Since announcing a more flexible approach to these demonstrations through a November 2017 Medicaid policy announcement, the Trump Administration has accelerated efforts to help states combat the national opioid epidemic, decreasing overuse and saving lives.

 “The Trump administration is committed to offering a more flexible, streamlined approach to accelerate states’ ability to expand addiction treatment services during this national crisis,” said CMS Administrator Seema Verma, “Whereas only a handful of states were approved for these demonstrations before 2017, our approach has allowed us to approve nearly 20 more demonstrations in just 18 months.”  Under the Minnesota demonstration, Medicaid eligible individuals will receive enhanced mental health services through Minnesota’s Certified Community Behavioral Health Clinics (CCBHCs). Temporary expenditure authority will allow CCBHCs to integrate community health care providers to increase rates of identification, initiation, and engagement in treatment for SUD.  

CMS expects the Nebraska demonstration will enhance existing substance abuse related services and offer those services to beneficiaries in more appropriate treatment locations, including residential facilities.  As a result the anticipated outcome is that more patients will receive a more complete array of required treatments than before the demonstration.

States will monitor and report the impact of changes to address SUD and OUD over the course of the demonstrations. States who have already implemented their programs are beginning to report positive results. For example, Virginia experienced a 4 percent decrease in acute inpatient SUD admissions during the first 10 months of implementation, along with a 6 percent decrease in opioid use disorder inpatient admissions. During the first year, the total number of prescriptions for opioid pain medications among Medicaid beneficiaries decreased by 27 percent while the number of prescriptions for non-opioid pain relievers remained unchanged. In one year of early implementation of the Maryland demonstration, over 8,000 Medicaid beneficiaries received residential treatment services.

Expanding access to treatment for people with opioid use disorder (OUD) is one key strategy identified in CMS’s Roadmap to Address the Opioid Epidemic, which details agency efforts in combatting the opioid crisis. More than two million people suffer from OUD, yet only 20 percent of people with OUD receive treatment. These demonstrations will allow Minnesota and Nebraska to improve access to high quality, clinically appropriate treatment for OUD and other SUDs, in ways that take into account the particular challenges the opioid epidemic has caused in their respective states. Both demonstrations are approved for a five year period beginning on July 1, 2019, and ending on June 30, 2024.

For More information regarding the Minnesota and Nebraska, demonstrations please visit:

Minnesota: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/mn/mn-sud-reform-ca.pdf

Nebraska: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ne/ne-sud-demo-ca.pdf

States with previously approved demonstration approvals include Illinois, New Jersey, Louisiana, Indiana, Kentucky, Utah, Vermont, Pennsylvania, New Hampshire, Washington, North Carolina, Wisconsin, Alaska, New Mexico, Kansas, Rhode Island, Michigan, Massachusetts, Maryland, Virginia, California and West Virginia.

CMS Commits $50 Million to Assist States with Substance Use Disorder Treatment and Recovery

Notice of Funding Opportunity will award 18-month planning grants to at least 10 State Medicaid Agencies

Today, the Centers for Medicare & Medicaid Services (CMS) announced a Notice of Funding Opportunity that provides State Medicaid agencies with information to apply for planning grants that will aid in the treatment and recovery of substance use disorders (SUDs), including opioid use disorder (OUD). Fighting the opioid epidemic is one of CMS’s top priorities, and the planning grants are an important step in that effort.

The planning grants are intended to increase the capacity of Medicaid providers to deliver SUD treatment or recovery services through an ongoing assessment of the SUD treatment needs of the State; recruitment, training, and technical assistance for Medicaid providers that offer SUD treatment or recovery services; and improved reimbursement for and expansion of the number or treatment capacity of Medicaid providers. To apply, State Medicaid agencies are required to submit an 18-month proposal by August 9th to increase the capacity of Medicaid providers throughout the State and quickly deliver SUD treatment or recovery services within local communities. CMS will review all of the applications and select at least 10 proposals, with awards totaling $50,000,000.

“CMS is pulling every lever to combat the opioid epidemic, and increasing access to treatments for Americans suffering from substance use disorder is essential to addressing this issue," said CMS Principal Deputy Administrator for Policy and Operations Kimberly Brandt. State-level innovation has been and will continue to be key in addressing the opioid crisis and this funding opportunity provides states with a significant opportunity to expand access to critical treatments for their citizens.”

CMS has a comprehensive three-pronged approach to combat the opioid crisis, which is laid out in the CMS Roadmap to Address the Opioid Epidemic and focuses on prevention, treatment, and data. The implementation of section 1003 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (P.L. 115-27) and the release of this Notice of Funding Opportunity represent a key aspect of our efforts to increase access to evidence-based treatment for OUD.

The application for planning grants is the first step CMS is taking in implementing section 1003 of the SUPPORT for Patients and Communities Act. Enacted on October 24, 2018, the SUPPORT for Patients and Communities Act is a comprehensive bill that tackles multiple aspects of the epidemic including treatment, prevention, recovery and enforcement. Section 1003 authorizes CMS to conduct a 54-month demonstration project to increase substance use provider capacity, beginning with this 18-month planning phase. Upon completion of the planning phase, up to 5 states will be selected to carry out a subsequent 36-month demonstration.

Task Force Editorial on Social Determinants of Health

AFP Publishes Editorial on U.S. Preventive Services Task Force Recommendations and Social Determinants of Health

The American Family Physician recently published an editorial about U.S. Preventive Services Task Force recommendations and social determinants of health, authored by Task Force vice chair Alex Krist, Task Force member Karina Davidson, and the Scientific Director of the Task Force program at AHRQ, Quyen Ngo-Metzger. The editorial, entitled “What Evidence Do We Need Before Recommending Routine Screening for Social Determinants of Health?” focuses on:

  • The two Task Force recommendations that directly address social determinants of health, screening for intimate partner violence and screening for child maltreatment, and a review of other Task Force recommendations related to social needs.
  • What is needed before recommending routine screening for social needs: an accurate screening test, an effective treatment, and a meaningful health outcome improvement for patients.
  • What clinicians can do in the absence of evidence-base recommendations on social needs.

The editorial concluded that primary care clinicians need more evidence about their role in addressing social determinants of health, and community resources and public health support is needed to help patients with unmet social needs. To read the editorial, go here.

Study funded by NIH supports optimal threshold for diagnosing COPD

Approximately 16 million Americans have COPD.

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NIH-funded trial finds vitamin D does not prevent type 2 diabetes in people at high risk

Study is largest to examine daily supplementation.

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NIH funds clinical trials using genomics to treat chronic diseases

The National Institutes of Health will fund clinical trials to assess the benefits, applicability and efficacy of applying genomic medicine interventions to improve management of diseases such as high blood pressure, depression and chronic pain. The trials are part of the second phase of the Implementing Genomics in Practice (IGNITE) Network with a total investment of $42 million over five years, pending the availability of funds. The trials will begin in 2020.

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ADA updates its “living" guidelines based on CREDENCE trial

Takeaway

  • The American Diabetes Association (ADA) has updated 2 sections in its online “Living” Standards of Medical Care, based on the recently reported Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy (CREDENCE) trial results.

Renal Management Guidelines Update

  • Section 11, on Microvascular Complications and Foot Care, now includes the following recommendations (graded A, B, C):
    • 11.1 At least once yearly, assess urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate (eGFR) in patients with type 1 diabetes with duration of ?5 years, in all patients with type 2 diabetes (T2D), regardless of treatment, and in all patients with comorbid hypertension. B
    • 11.3 For patients with T2D and diabetic kidney disease, consider use of a sodium-glucose cotransporter 2 inhibitor in patients with eGFR ?30, particularly in those with >300 mg/g albuminuria to reduce risk of chronic kidney disease (CKD) progression, cardiovascular events, or both. A
    • 11.3 In patients with CKD at increased risk for cardiovascular events, use of a glucagon-like peptide-1 receptor agonist may reduce risk of progression of albuminuria, cardiovascular events, or both. C
  • Section 10, Cardiovascular Disease and Risk Management:
    • Now includes information about CREDENCE and CANVAS.
    • Section was endorsed by the American College of Cardiology.

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FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering

[4-9-2019] The U.S. Food and Drug Administration (FDA) has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.

While we continue to track this safety concern as part of our ongoing monitoring of risks associated with opioid pain medicines, we are requiring changes to the prescribing information for these medicines that are intended for use in the outpatient setting. These changes will provide expanded guidance to health care professionals on how to safely decrease the dose in patients who are physically dependent on opioid pain medicines when the dose is to be decreased or the medicine is to be discontinued.

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Update on Interventions to Prevent Opioid Use Disorder

The USPSTF is deeply committed to addressing the opioid epidemic by promoting primary care strategies to prevent opioid misuse and opioid use disorder. After careful consideration of public feedback on this issue, the USPSTF has determined that it can best help address the opioid epidemic by identifying what new research is most needed on primary care strategies for preventing opioid misuse and opioid use disorders. 

The USPSTF has recommendations related to opioid use including screening for use of illicit drugs and misuse of prescription drugs and interventions to prevent drug use in adolescents and young adults.